American journal of medical quality : the official journal of the American College of Medical Quality
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We developed a continuous quality improvement (CQI) program for anesthesia services based on self-reporting of critical incidents and negative outcomes through a dichotomous (yes/no) response on the anesthesia record. Immediate case investigation provides data for systematic peer review of anesthesia management. Trend analysis of the database of critical incidents and negative outcomes identifies opportunities for improvement. ⋯ Among the 537 cases with anesthesia management problems were 119 human errors and equipment problems (22%). Regional nerve blocks and airway management represented the most common problem areas. Improvement in anesthesia services was made through prompt implementation of strategies for problem prevention devised by the practitioners themselves through peer review, literature review, and clinical investigations.
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Approximately 12 million red blood cell units are transfused to nearly 4 million patients annually in the United States (1). The conservation of blood has historically arisen from awareness that the inventory of this resource is limited (2), as well as the knowledge that blood transfusion carries a risk (3). Estimates of current blood transfusion risks (4-12), and the costs of transfusion complications (13-17), are summarized in Table 1. ⋯ Furthermore, these guidelines along with consensus conference recommendations (22) have emphasized that if blood is to be transfused, autologous (the patient's own) blood is preferable to allogeneic (from an anonymous, volunteer donor) blood. Thus, the costs of blood conservation, for which an increasing array of technologic procedures and products have become available (Table 2), have also become an issue (23). The purpose of this review is to provide an overview of emerging data on the cost-effectiveness of blood and blood conservation interventions in order to help identify areas important for future investigation.